Healthcare Provider Details

I. General information

NPI: 1295847507
Provider Name (Legal Business Name): WILLIAM GARY BACHMAN OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 09/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7800 NATURAL BRIDGE RD 1 UNIVERSITY BLVD
SAINT LOUIS MO
63121-4617
US

IV. Provider business mailing address

ONE UNIVERSITY BLVD 115 MARILLAC HALL
ST LOUIS MO
63121
US

V. Phone/Fax

Practice location:
  • Phone: 314-516-5131
  • Fax: 314-516-5507
Mailing address:
  • Phone: 314-516-5131
  • Fax: 314-516-5507

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberT02108
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: